Category: Health

T2DM & You

April 28, 2022 Return

Dr Hew Fen Lee

Consultant Endocrinologist

You have surely heard of diabetes in the past, but after being diagnosed with the condition, diabetes is no longer an issue that affects other people. It is now affects you.

Before you can take control of your health and life, you should know the facts about diabetes, such as why it is happening to you and what it can do to you. Such information may be harsh or frightening, but the more you know about diabetes, the more you will understand why you need to commit to the lifestyle changes that will help you control the condition.

You will understand that all is not lost, and there is no need to give up when the going gets tough. There are many diabetics out there who live healthy and fulfilling lives by making the necessary changes, and there is no reason why you cannot be one of them.

So let us take a better look at type 2 diabetes mellitus (T2DM).

An issue of insulin resistance

Many people believe that T2DM is a disease caused by eating too much sugar. This is not true.

“T2DM is a problem caused by insulin resistance,” explains Dr Hew. “Patients with T2DM are usually insulin resistant, which means they require more insulin to control their glucose level, more than their body can produce.”

First, let us start by taking a look at the pancreas. Our pancreas is an organ located behind the lower part of the stomach, and it produces insulin, the hormone responsible for regulating blood glucose levels.

Our body needs glucose for energy. Our digestive system breaks down the carbohydrates in our meals to glucose. Therefore, after each meal, the amount of glucose in the blood typically rises.

In a healthy person, the pancreas detects this rise in blood glucose level. It then releases insulin into the bloodstream, and insulin attaches itself to the appropriate cells in our body. The attachment of insulin alerts these cells to begin absorbing glucose from the blood stream. This action helps to remove excess glucose from the bloodstream, keeping the blood glucose level within a healthy range. The more glucose is present in the bloodstream, the more insulin would be released by the pancreas.

In someone with insulin resistance, the pancreas produces insulin each time it detects high blood glucose level in the bloodstream. However, the cells of the body do not respond normally to insulin.

We don’t know all the causes of insulin resistance, but researchers strongly believe that excessive weight and lack of physical activity are 2 important and significant causes. Most patients with T2DM are overweight and they lead sedentary (inactive) lives.

According to Dr Hew, because of insulin resistance, more insulin is required to control the blood glucose level. This exerts pressure on the pancreas to produce higher amounts of insulin than normal.

“Over time, the insulin resistance builds up to a level at which the pancreas can no longer keep up with,” says Dr Hew. “A shortfall of insulin occurs, and the blood glucose level in the blood is no longer controlled adequately, causing it to rise above the healthy limit.”

Insulin resistance slowly builds up over time, so many people may not know that they have T2DM until the condition has progressed to a later stage and controlling it becomes more difficult.

So what happens now?

If left unchecked, T2DM can lead to various health conditions (complications) that can severely affect the patient’s quality of life and can even possibly lead to early death.

According to Dr Hew, T2DM patients are at risk of the following:

Eye problems (retinopathy).
Kidney problems, including urine infection and kidney damage.
Damage to blood vessels, which can lead to heart problems, stroke and poor blood circulation. The latter can give rise to poor sensation, especially in the feet, increasing the risk of nerve damage, infections, ulcers and tissue death and possibly requiring amputation.

Managing your diabetes

According to Dr Hew, there are 3 cornerstones in good management of diabetes, all of which should be practised.

All 3 work together to help control T2DM. We cannot just focus on 1 aspect alone, which is why it is important to work closely with our healthcare team to come up with a plan that helps coordinate all 3 aspects of T2DM management in our lives.

Why manage T2DM?

Managing the condition is important to slow its progression and reduce the risk of health problems that can arise over time. The principle of T2DM management is to adopt a healthy lifestyle which should apply to anybody with or without diabetes. Dr Hew points out that a good control of diabetes often allows the patient to lead a healthy and normal life while minimising the complications normally associated with T2DM.

Dr Hew believes that, when one is armed with the right knowledge and a bit of determination and discipline, achieving good diabetes control is not too difficult. “You should make health your No. 1 priority now,” he urges. “Once you keep this in mind, everything else becomes easier.”

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You Can Do It!

April 28, 2022 Return

Your mind may be reeling from the diagnosis that you have diabetes. The changes you need to make in your life may be overwhelming at first. Don’t worry; take your time to let the diagnosis sink in and, once you are feeling calmer, reassess your situation.

What are we aiming for?

In diabetic management, the goals are:

To keep your blood glucose levels as normal as possible, and as stable as possible (without going too high or too low)
To prevent high blood glucose levels from causing damage to the organs in your body.

To ensure that you are on the right track, you will need to constantly monitor your condition through a series of tests. Some tests can be conducted on your own, such as monitoring your blood glucose, while others involve your healthcare team extracting a sample of your blood to be analysed in the laboratory.

**Source: Ministry of Health Malaysia. (2009). Clinical practice guidelines (CPG) on management of type 2 diabetes mellitus (T2DM) (4th ed.). Putrajaya: Health Technology Assessment Section.**
Types of tests	Target values
Blood glucose (glycaemic) control • Fasting • Non-fasting • HbA1c	4.4 – 6.1 mmol/L 4.4 – 8.0 mmol/L < 6.5%
Lipid control • Triglycerides • HDL cholesterol • LDL cholesterol	≤1.7 mmol/L ≥1.1 mmol/L ≤2.6 mmol/L
Blood pressure • When kidney function is normal • When there is a kidney problem	≤130/80 mmHg ≤125/75 mmHg

While the above figures may not mean much to you now, they represent the goals of your diabetes management. By comparing your results to those in the table, you will know whether you are on the right track. We will discuss more about this in the later pages.

For now, you should understand that there is a purpose for keeping to these goals. For example, research has found that even a small reduction in HbA1c has great positive impact on your health.

Just 1% reduction in HbA1c gives

21% reduction in risk of death related to diabetes
37% reduction in risk of complications from damage to small blood vessels (microvascular complications)
14% reduction in risk of heart attack (myocardial infarction)

Therefore, do not wait until you are feeling ill before taking action. Take steps to manage your diabetes as soon as possible. After all, every little improvement can go a long way in ensuring that you have a healthy and fulfilling life despite your diabetes!

Take charge of your health

When it comes to T2DM, you are primarily responsible for its management.

Yes, you read that correctly. It may be tempting to rely solely on your healthcare team to guide you, but a big part of good diabetes management relies on your own determination to stay healthy. You will be the one responsible for taking your medications and making the necessary changes in your lifestyle.

So, it is important that you know what you are doing. Don’t let the changes in life overwhelm you – that is the fastest route to giving up and letting T2DM get the better of you.

You can stay healthy, for yourself and your loved ones. You can do it. Stay focused, and you will be fine.

Planning your next steps

Educate yourself. Read up on T2DM from authoritative sources, such as books and websites. However, there is much misinformation on T2DM out there, so discuss with your healthcare team on what you have found to ensure that your sources are accurate.
Be proactive. Your healthcare team will work with you to come up with medication and lifestyle plans to help you manage your T2DM better. Ask questions when you have doubts. Do not worry about being seen as “fussy” or “problematic”, as most healthcare teams will be happy to answer your questions. Make sure you know exactly what you need to do.
Start your own journal, as it would be good to record your medication, food and self-monitoring values. Your records would be useful during consultations with your healthcare teams as well as during medical emergencies.
Share with your family the lifestyle changes you need to make. It is greatly recommended that the entire family make the changes associated with diet and physical activity together, as this only contributes to the success of your T2DM management as well as the overall health and wellness of the entire family. If you have difficulties convincing your family to make these changes, share your concerns with your healthcare team. They would be happy to help facilitate discussions with your family members.

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Understanding Your Oral Medications

April 28, 2022 Return

Prof Dr Norlaila Mustafa Consultant Endocrinologist, Universiti Kebangsaan Malaysia Specialist Centre.

According to Prof Dr Norlaila Mustafa, a consultant endocrinologist who runs a diabetes clinic, oral diabetes medications are designed to help you manage your blood glucose level and currently, there are many types available. Your doctor will prescribe the types of medication that are appropriate for you, depending on your body’s response to insulin as well as other health conditions you may have alongside diabetes.

Diabetes medications do not cure diabetes. Dr Norlaila points out that it is just as important to follow a meal plan and exercise regularly to manage your weight to slow the progress of diabetes and reduce the risk of damage to your brain, kidney, liver, eyes, heart, nerves and more.

5 good medication habits

Dr Norlaila recommends the following:

Follow your doctor’s advice when it comes to monitoring your blood glucose level in order to check your response to the medications prescribed.
Refill your medications when they run out. Diabetes medications should be taken continuously, not just when you are feeling unwell, in order to slow the progression of the disease.
Too busy to take your medication? Download a smartphone app to help you schedule your time.
Do not share your medication with other people. Medicine is one of the few things in life that you should always keep to yourself!
Keep a list of all the medications you are on (write down the name displayed on the packaging) as well as any supplements or alternative medications. This list will be useful during medical emergencies.

Metformin: The frontline against diabetes

According to Dr Norlaila, most diabetes patients are on metformin, for good reasons.

Along with proper diet and regular exercise, metformin is effective in helping the patient control his or her high blood sugar level.
It can be taken by most type II diabetes patients without experiencing dangerous side effects.
It is also affordable, and therefore, can be purchased by most patients without straining their finances.

“Because of its effectiveness on many patients with type II diabetes, doctors usually prescribe metformin as the first option when it comes to treating the disease,” adds Dr Norlaila.

Metformin is considered by many as a “wonder drug” due to how effective it is. In fact, its discovery changed the way we treat diabetes for the better, improving the quality of life and life expectancy of diabetes patients.

Dr Norlaila goes on to explain that metformin helps you manage your blood glucose level in several ways.

Your liver produces glucose, which adds to the glucose you obtain from your meals. Then, metformin helps to decrease the amount of sugar produced by your liver.
It also helps to reduce the amount of glucose absorbed by your body during the digestion of food.
It helps to improve your body’s sensitivity to insulin, allowing your liver, muscle cells and fat cells to take in more glucose from your blood. This reduces the overall amount of glucose in the blood.

Taking metformin. Metformin is available in tablet and liquid forms. Depending on the severity of your disease, your doctor may recommend taking them 1 to 3 times a day after meals. There are also extended release tablets in the market, which only requires you to take 1 tablet a day, usually during your evening meal. You should follow your doctor’s instructions, restock your metformin when it runs out and continue to take your metformin even when you are feeling healthy.

Side effects. Like many medications, metformin can potentially cause side effects in certain people. Milder side effects include: diarrhoea, indigestion, bloating and stomach pain, constipation, heartburn, headaches, muscle aches and an unpleasant metallic taste in the mouth. More severe side effects include chest pain and rashes. Dr Norlaila advises that you should alert your doctor if you experience any of these side effects over a prolonged period of time.

Very rarely, a patient with renal failure may develop a potentially fatal reaction to metformin called lactic acidosis. Such patients should take other forms of medication for their diabetes. Besides, metformin may not be suitable for patients with problems relating to the heart, kidneys and liver. Fortunately, Dr Norlaila mentions that there are other alternatives to metformin, termed the second line medications, which may be suitable for them.

Second line medications

Second line medications are those that are given to patients in order to support or complement the effects of metformin for better blood glucose management. They may also be given to patients for whom metformin is cannot be used (contraindicated), perhaps due to side effects, kidney problems and such.

Dapagliflozin: improving blood glucose control

Dapagliflozin is an interesting drug in that, unlike most diabetes drugs that target the pancreas or and liver, it works on the kidneys. “It helps to reduce blood sugar by increasing the amount of glucose excreted in the urine. It may also help with weight loss and improvement of blood pressure,” explains Dr Norlaila.

To help you gain a better understanding of how this drug works, let us first take a look at the link between glucose and our kidneys.

Your kidneys: it’s not just about urine

The kidneys are the main waste disposal factory in our body, so let us imagine a kidney as a big building. Inside the building are about a million little filtration machines called nephrons. The nephron is the key structure responsible for controlling the amount of substances present in the urine.

The glomerulus is the filtration structure – it makes sure that only the right substances that can fit through its pores will end up in the urine. Glucose is of the right size, so it can pass from a blood vessel through the glomerulus without any difficulty.

Normally, urine contains no glucose because the nephron has a system in check to reabsorb any glucose that passes through the glomerulus filter. What happens is that any glucose that strays into the nephron eventually makes its way to the proximal convoluted tubule.

Lying in wait there are special transporters called “sodium-glucose linked transporter (SGLT)” or “sodium-dependent glucose co-transporter”. Like their name suggests, they absorb glucose back into the blood along with sodium. Just like how there are different models of Proton cars, there are different types of SGLTs, such as SGLT-1 and SGLT-2. SGLT-2 is the main transporter in the proximal convoluted tubule.

“About 90% of the glucose filtered in the nephron is reabsorbed with the help of the SGLT-2,” Dr Norlaila points out. Any remaining glucose that manages to elude the SGLT-2 is “caught” by SGLT-1 in a later, straight part of the proximal tubule.

In the case of a type II diabetes patient, the blood glucose level can be high, so it is a good thing if the glucose that finds its way into the kidneys is not reabsorbed but instead, removed from the body via urine.

This is where dapagliflozin steps in. “The drug inhibits the action of SGLT-2, therefore drastically cutting down the amount of glucose that would be reabsorbed back into the blood stream,” says Dr Norlaila. For someone with diabetes, that is a good thing!

Indirectly, dapagliflozin may also help with weight loss as it reduces the amount of calories stored in the body after each meal as well as to reduce one’s overall sense of hunger. However, it should not be considered as a weight-loss drug. Studies suggest that the drug may also help in reducing high blood pressure.

Taking dapagliflozin. Dapagliflozin can be prescribed alongside metformin, or can also be prescribed on its own. In general, it can be prescribed to patients with any stage of diabetes. Ask your doctor for more information.

Who should not take it? This drug may not be suitable for patients who are pregnant or breastfeeding, having kidney problems, having low salt levels in their body, or those with history of dehydration and have been admitted to the hospital. Check with your doctor for more information.

More second line medications

Dr Norlaila mentions some other common medications for diabetes.

Drug group	Examples	How they work
Sulfonylurea	Glimepiride Glyburide Glipizide Micronized glyburide	Increases the amount of insulin released by the pancreas over a few hours after a meal.
Meglitinides	Repaglinide	Increases the amount of insulin released after each meal.
D-Phenylalanine derivatives	Nateglinide	Increases the amount of insulin released after each meal.
Thiazolidinediones (TZDs)	Pioglitazone	Increases the sensitivity of the body towards insulin.
DPP-4 inhibitors	Sitagliptin Saxagliptin Linagliptin	Increases insulin level after a meal while decreasing the amount of glucose produced.
Alpha-glucosidase inhibitors	Acarbose Miglitol	Lowers the rate of carbohydrate absorption into the body after a meal.
Bile acid sequestrants	Colesevelam	Helps lower glucose level.

Combination pills are also available, often combining the effects of 2 different medications (for example, metformin and a second level medication) for the purpose of convenience and reducing the number of pills you need to take.

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Eat, Move, Stay Healthy

April 28, 2022 Return

“The typical response from people when I tell them I’m diabetic is, ‘Oh, I’m sorry to hear that.’ You know, I’m not. I’m a better athlete because of diabetes rather than despite it. I’m more aware of my training, my fitness and definitely more aware of nutrition. I’m more proactive about my health.” – Charlie Kimball

“What should I eat?” you may be wondering. Should you cut out carbohydrates from your diet? Should you adopt one of the many diets out there said to be designed just for diabetics?

Actually, the good “old-fashioned” healthy and balanced diet – advocated by nutritionists for everyone young and old, healthy or suffering from a chronic condition – is still an effective option for diabetics like you.

Your nutrition goals

You will be working with your dietitian to plan your meals. This may seem complicated at first, but don’t worry, you will soon get the hang of it.

Practice carbohydrate counting. Basically, you would have to make sure that you are aware of how much carbohydrates you are having in each meal, and carbohydrate counting allows you to ensure that your meals do not contain too much of it. If you are on insulin, knowing how much carbohydrate is present in a meal is important to ensure that you get the right dosage.
Eat food in appropriate portion sizes. A good way to start is to list down the usual portion sizes of the food you eat often and share them with the dietitian, who will advise you on how much to cut down. You will then be using measuring cups and a scale to make sure that your meals are all in the right portions.
Think well-balanced. You will include a good mix of every food group to make sure that you get all the nutrients you need to stay healthy. For carbohydrates, you should choose fruits, vegetables and whole grains as they contain what we call complex carbohydrates (such as starch and fibre). Such foods can help keep your blood glucose level stable while still providing energy. Consult your dietitian on the types of food that would best suit you at your current state of health.
Avoid food and drinks that contain added sugar. In addition to glucose, you should also avoid food and drinks that contain sucrose, high fructose corn syrup and other types of sugar. You can check the ingredient list on the bottle or package to be certain. Such drinks tend to be high in calories but low in nutritional value, and their sugar content can cause your blood glucose level to rise rapidly.

However, if you are experiencing the effects of low sugar level such as dizziness and sleepiness, such drinks can be used as a way to quickly raise your blood sugar.

Changing your eating habits for the better

It can be hard to change your diet, as it often requires discipline, willpower and the ability to unlearn bad eating habits – all of which can take time, and you may become frustrated and even feel tempted to give up along the way.

Here are some tips to help you stay on course despite the various challenges and frustrations you will encounter:

On your mark…

Don’t try to make many big changes at once, as you would only be setting yourself up for failure. Instead, start simple.

Sit yourself down, then, list all the possible eating habits you have. You can enlist the help of family members, as sometimes you may have habits that you are not aware of. Typical bad eating habits include: eating while watching the TV or computer, stress snacking, eating too-largefood portions, enjoying high-fat meals and so on.

Next, list all the good eating habits you would like to adopt. You can consult your dietitian for advice if you are unsure of what these habits are.

Now, pick 5 bad habits you would like to break, and 5 good habits you would like to adopt.

Get set…

To get ready for this new you, pick a “start date”. The weekend is always a good time, as you have more time to focus and there are fewer distractions. Also, set a realistic “end date” for you to evaluate your progress.

In the meantime, make sure that you are clear on what you need to do. Consult your healthcare team to share with them your plans, and make sure you have a good blood glucose monitor at hand.

Go!

On the start date, jump right in! Break 5 bad habits, adopt 5 good habits! Remember to detail your efforts and progress in your journal for you and your healthcare team to review after the end date.

At the end date, if you have achieved your goals, it is time to pick another 5 good habits to adopt as well as another 5 bad habits to break. Of course, you must also maintain your current progress. We will not lie; it will not be easy. However, there are ways to keep yourself motivated.

Don’t forget to move!

Regular physical activity is a good way to burn excess calories, keep your weight within healthy limits and strengthen your body. Not only does regular physical activity slow down or halt any damage caused by the progression of diabetes, it can also lift your mood or de-stress you.

The Malaysian Clinical Guidelines on Management of Type 2 Diabetes Mellitus (2009) recommends 150 minutes of physical activity a week. This boils down to about 20-30 minutes a day.

If you are not active before, or if you suffer from a condition that may make exercising difficult, share your plans with your healthcare team. They will advise you on the most appropriate types of physical activity you can adopt.

It can be hard to get the body moving, especially if you are used to a sedentary lifestyle. Give up your TV time to go jogging? You may instinctively balk at the thought. Still, with some determination and our tips, you will soon be moving and enjoying every minute of it!

Making it fun. If sports or hitting the gym is not your thing, pick an activity that you will enjoy, or one you can do in the company of people you like. Ballroom dancing, yoga, tai-chi and weekend walks to a picnic spot are some options worth considering.

Think outside the box. There are other forms of physical activity which are not the typical recreational ones. For example: take the stairs instead of the elevator, walk instead of driving, devote more time to gardening and house work. If you love window shopping, spend more time walking in your favourite malls, and park a little farther away from the entrance.

Use a pedometer to measure how many steps you take a day, and slowly build up your walking rate so that you will eventually walk about 10,000 steps a day.

Find and channel your motivation

The first few weeks of your new adventure will be the hardest, as you will be trying to replace habits you enjoy with habits that you may not enjoy doing as much, at the beginning. Going lunch with your colleagues can be a challenge in itself, as you would be tempted by all the delicious but unhealthy foods that you used to enjoy indiscriminately!

There may also be moments when you become frustrated at your slow progress, and you may even experience a degree of “withdrawal symptoms” of the favourite foods and old habits that you have enjoyed all this while.

During those moments, your resolve may waver, tempting you to give up because everything seems so impossible. Don’t succumb to it! Stay focused. You can do it.

Here are some tips to help you strengthen your resolve.

Know why you are doing this. It is not enough to say that you want to be healthy, as sometimes it can be hard to remember why this is important when you are craving for chocolate ice cream.

So, list down more specific reasons. Perhaps you want to stay healthy for your children and your partner as well as yourself? What are the dreams and goals you want to achieve, but will not be able to do so if your diabetes worsens? These reasons do not even have to be long-term in nature. Perhaps you want to lose weight to fit better in a bikini and impress everyone when you saunter down the beach later the year. There is no right or wrong motivation – so long as it matters to you, it’s worth listing down and remembering.

Paste your list in a prominent place where it can be spotted easily, especially when you are feeling vulnerable, such as at the door of your refrigerator, the monitor of your computer or even as a reminder on your mobile phone.

Don’t do this alone. Support from other people is a powerful motivator to keep you going. Therefore, enlist a family member, friend or co-worker for support. Support can come in many forms, such as a diet or exercise partner, but sometimes, even just having someone to confide your joys and frustrations in can be a great boost to your morale.

If you have problems finding someone close to you who is willing to support you, why not branch out? For example, you can:

Organise a weight-loss or exercise group at your workplace or neighbourhood.
Join a support group. If you cannot find one in your neighbourhood, you can search for an online support group.
Connect with fellow diabetics via a blog, Facebook account or other social media platforms, and share your progress and frustrations with them.

Don’t be discouraged by lapses. Occasionally you will slip up. Do not let this bring you down. Review the possible causes for your lapse, and work to overcome them. If you find yourself lapsing often, consult your support group or healthcare team on how you can stay motivated.

“My mom passed away at 41 from diabetes. And I’m 42, thank you. I didn’t want to do that to my son. So any time I was at the gym, that thing that helped me do that last squat was my son calling some other woman mommy. And that would just give me that extra oomph to do that last squat. I want to be around for him.” – Sherri Shepherd

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The Right Check

April 28, 2022 Return

You may be eating and exercising according to your healthcare team’s recommendations while faithfully taking your medications. But how do you know if you are doing the right thing when it comes to managing your diabetes?

The answer is pretty simple: regularly monitor your blood glucose level and keep a record of your progress.

Self-monitoring

Self-monitoring alerts you to the possibility of whether you are hyperglycaemic or hypoglycaemic after a meal. Knowing the results early will allow you to take quick actions in restoring your blood glucose level to within a healthy range.

Also, self-monitoring allows your healthcare team to measure the progression of your diabetes and adjust your medications accordingly. This is why you should self-monitor even when you show no signs of illness, and keep a record of the results.

**Your blood glucose target**
Fasting Non-fasting HbA1c	4.4 – 6.1 mmol/L 4.4 – 8.0 mmol/L < 6.5%

When should you monitor your blood glucose?

According to the Malaysian Clinical Guidelines on Management of Type 2 Diabetes Mellitus (2009), the following practice is recommended.

	Breakfast	Lunch	Dinner
On oral medication only	Check before and after	Check after	Check after
On insulin	Check before	Check before	Check before and after

Monitoring by your healthcare team

Your healthcare team monitors the progress of your diabetes management efforts by measuring the following:

Blood glucose level. Check with your healthcare professional whether you need to fast before they measure your blood glucose level.
Urine testing. This is to determine whether your kidneys are functioning properly.
HbA1c. HbA1c refers to the protein in your red blood cells, haemoglobin, which are bonded to glucose to give what we call “glycated haemoglobin”. By determining your HbA1c value (measured in %), your healthcare team will get a good idea of your blood glucose level over the last 2 or 3 months. (This is why you cannot fool your healthcare team by starting to manage your diet only a few weeks before your medical appointment!)
Blood pressure. This is to gauge whether your cardiovascular system is in good order.
Blood lipid level. By measuring the amount of cholesterol and triglycerides in your blood, your healthcare team would have a good gauge of your risk of heart disease, which is usually increased in diabetics, especially those with weight problems.

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Delaying Menses for Hajj

April 28, 2022 Return

Professor Dr Jamiyah Hassan Senior Consultant OBGYN, Feto-Maternal Specialist, University Malaya Medical Centre

Each year, millions of Muslims undertake the pilgrimage to Mecca during a 5-day period, from the 9th to the 13th of Dhu Al-Hijjah, the 12th month of the Muslim lunar calendar. This pilgrimage is both a religious goal and the high point of a Muslim’s life. For Muslim women preparing for the Hajj, however, there is always a question lurking at the back of their minds: what if they were to menstruate during those precious days?

“Muslim women are not allowed to perform religious activities such as fasting and praying when they have their menses,” explains Prof Dr Jamiyah Hassan. “This extends to performing the Hajj.”

Dr Jamiyah, speaking at the Women’s & Men’s Health Intertwined seminar conducted by the Obstetrical and Gynaecological Society of Malaysia (OGSM) recently, said that combined oral contraceptive pills (COC, sometimes better known as “the pill”) can be used to delay menses during pilgrimage.

Religious decisions

The use of COC involves manipulating the female hormones. Is such a method allowed?

There is no fatwa on delayed menses by the National Fatwa Council, according to Dr Jamiyah. She however points out to specific fatwa in the states. For example in 1985, the Penang Fatwa Council stated that Muslim women are allowed (harus) to delay their menses for the purpose of Hajj, due to the distance travelled for the pilgrimage as well as the difficulty of performing the Hajj ritual. She has also spoken to many religious figures who agreed with this fatwa.

Delaying the period

According to Dr Jamiyah, any COC would work for this purpose, but she recommends choosing the newer brands of COCs. This is because in newer COCs, the active ingredient progestogen is designed to have a longer half-life and therefore, these COCs are more effective.

She offers the following general tips:

Start a month earlier, as your body needs time to acclimatise to the changes to your menstrual cycle.
A traditional pill pack contains 28 pills, but only 21 are active. The other seven pills are inactive. Discard the nonactive pills, and continue taking the active pills until you have returned to Malaysia.
If you bleed during the Hajj, you can still perform your religious duties, provided you clean up first. Dr Jamiyah explains that, according to the fatwa, such bleeding is not considered normal menses as it is the result of hormonal manipulation.

These are only general guidelines. Dr Jamiyah advises women hoping to delay their menses to first consult their doctor, for appropriate dosage and other important information.

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Stop It From Striking You! Hard!

April 28, 2022 Return

troke strikes its victims swiftly and mercilessly, leaving survivors in debilitating conditions to recover from.

According to the National Stroke Association of Malaysia (NASAM), stroke is the third leading cause of mortality in Malaysia with an estimation of 40,000 Malaysians suffering a stroke at some point in their lives. And this can happen to anyone of any age. You may even die if swift action is not taken. Scary, eh?

Who is at risk?

Stroke risk increases with age
Smokers
Diabetics
Alcoholics
People with a family history of stroke
People who had prior stroke
People with high blood pressure
People with high cholesterol levels

A stroke is when the blood supply to the brain is either blocked or ruptured. This disrupts and deprives the brain cells of oxygen and nutrient supply. The part of the brain involved may start to die and affect certain bodily functions. The 3 kinds of stroke are:

Ischemic stroke: Blood supply to the brain is clogged by fatty deposits (atherosclerosis) or a blood clot.

Haemorrhagic stroke: Blood vessel ruptures and bleeds into the brain. This can be due to aneurysm, where a weak, thin spot in the artery balloons out and burst.

Transient ischemic attack: Otherwise known as ‘mini stroke’, it is a temporary occurrence where lesser blood supply than normal gets into the brain. This may last from a few minutes up to a day and clears off after. It can be a signal of an impending full stroke. Report to your practitioner if this happens.

But, it does not have to be that way. There are preventive steps to better prepare you from the imminent perils. Experts believe that 80% of stroke cases can be prevented, except those factors that cannot be controlled such as age, ethnicity and family history.

Keep blood pressure in check

The heart, being the main blood driver, pumps and circulates blood to our whole body. If the heart pumps harder due to reasons such as a blocked artery, this increases blood pressure and in turn, a stroke risk.

Have your blood pressure checked every 1 or 2 years by a practitioner. Or better still, purchase a blood pressure monitoring device. The ideal blood pressure should lie between 80 and 120.

Do you know that about 2 million brain cells die within the first minute of a stroke?

Quit smoking

Smoking can result in atherosclerosis, otherwise known as artery hardening. The plaque that builds up within the artery may partially or fully block the blood supply to organs and tissues. This, then, results in an increased blood pressure and stroke risk.

Seek help from a doctor on ways to quit smoking
Use nicotine patches and gums
Join support groups and programmes that can help you to quit

Get tested for diabetes and cholesterol levels

High blood sugar and cholesterol levels are contributory factors to the likelihood of a stroke. Lower your risks by:

Getting screened for blood sugar and cholesterol levels every 3 years after age 45, especially if you’re overweight/obese
Seek advice from health experts on diet and lifestyle choices

Call 999 whenever a stroke is suspected. Don’t delay.

Drink in moderation

Consume alcoholic beverages in moderation to avoid stroke. Limit your consumption to 1 drink per day and have a couple of ‘alcohol-free’ days.

Eat a balanced diet

A healthy, balanced diet promotes better health and in return, lowers your stroke risk.

Avoid a diet high in salt, saturated fats and cholesterol
Consume at least 8 to 10 servings of fruits and vegetables per day

Exercise, exercise!

A healthy weight can be maintained with exercise. Obesity and physical inactivity are linked to increased stroke risk. Staying active may reverse this effect as it can lower blood pressure, prevents blood clotting while shedding some weight.

Allocate at least 30 minutes per day to exercise.
Vary the types of exercise , so that the whole body is able to work out equally
Take the stairs instead of the elevator
Do a brisk walk on lunch breaks or if you are walking to the station

Should you take aspirins?

It is best to consult your doctor about aspirin use for stroke prevention. It can bring adverse side effects and may interact with certain pre-existing medications.

Act fast, beat the time!

Apply the FAST acronym to remember sudden stroke warnings. Dial 999 right away when it happens.

F for Face Drooping – Pay attention to the person’s face. Is it numb? Does it droop on one side? Get the person to smile. Is the smile even? It could be a stroke, if it is not even.

A for Arm Weakness – Does the person experience weakness in one arm? Get the person to raise both arms. Does one of the arms drift downward?

S for Speech Difficulty – Is the speech slurred? Is the person having difficulty understanding or talking to you? Get the person to repeat a simple sentence, such as “How are you?” Is it repeated accurately?

T for Time to call 999 – If the person exhibits any of the symptoms, dial 999 and promptly get the person to the hospital. Also, note the time of occurrence.

*Adapted from ‘Spot A Stroke’. Found in American Heart Association.

References:

American Heart Association. Available from www.strokeassociation.org

Blood Pressure UK. Available from www.bloodpressureuk.org

Liebman, B. (2007). Stroke: How To Avoid A Brain Attack. Nutrition Action Health Letter. 34(2): 1-7.

National Stroke Association of Malaysia. Available from www.nasam.org

Women’s Health. Available from www.womenshealth.gov

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Losing Your Voice?

April 28, 2022 Return

Now, let us examine what voice loss really is. It is usually a temporary condition due to inflammation of the larynx. Known as laryngitis, the hoarseness that normally comes with it does not make talking any easier.

Common causes of laryngitis:

Upper respiratory infection such as cold and flu
Tonsillitis
Sore-throat
Overuse of voice via talking, singing or shouting
Gastroesophageal reflux disease (GERD)
Smoking
Exposure to secondhand smoke or polluted air

The common symptoms are:

Hoarseness of voice
Voice loss
Headache
Pains when swallowing
A painful or sore throat

Most of the laryngitis cases are temporary and improve within a couple of days. However, not being able to use your voice properly (speaking, singing, presenting) in the meantime is a bummer, especially if you are a singer or having presentations to give. So, what can you do to feel better?

A proper rest: An ideal solution, especially if you have been straining your already inflamed vocal cord. Limit the amount you talk, shout or sing. And, DO NOT whisper. Whispering only worsens your inflammation as it makes your larynx work more and delays the recovery time.
Keep hydrated. Drink plenty of fluid as dehydration only deteriorates the condition.
Or..have some lemons. Hydrating your throat aside, drinking lemon juice can increase saliva production while destroying the bad germs in the throat.
Inhale humidified air. This can make you feel better as it soothes the airways while controlling the symptoms. Humidifiers can be purchased from most pharmacies. Or, create a humidified area yourself. The bathroom is usually the best place. Run the hot water in the shower until there is plenty of steam around. Spend about 15-30 minutes breathing in the warm, moist air. Be sure to drain the hot water to prevent burn risks.
Keep your throat moist. Increase saliva production by sucking on throat lozenges or chewing on gum to alleviate itchiness and reduce inflammation in your throat.
Gargle with an antibacterial mouthwash. The antibacterial properties can swish off the bad bacteria and virus that inhabit your mouth to make you feel better.
Or.. with salt water. This classic home remedy can effectively relieve throat irritation and inflammation. Salt has antibacterial properties that can remove bad germs and heal your inflamed throat.
Avoid smoking, alcohol and caffeine intake. Avoid smoking and limit your alcohol and caffeine intake as these can be irritants to your inflamed vocal cords.
If symptoms last more than 3 weeks or recurred continuously, contact your doctor for further treatments.
Antibiotics may not work. Although bacterial sources may be possible, laryngitis is usually due to viral infections. Therefore, it should be prescribed if bacterial infection is identified or suspected.

References:

About Health. Available from www.about.com/health

Find Home Remedy. Available from www.findhomeremedy.com

Live Science. Available from www.livescience.com

MedicineNet. Available from www.medicinenet.com

Patient.co.uk. Available from www.patient.co.uk

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Let’s Be Fracture-proof

April 28, 2022 Return

So, how exactly does a bone fracture occur? A bone fracture happens when part of the bone is chipped, cracked or completely broken. Further to that, resulting fragments may even damage surrounding tissues or blood vessels, which can cause swelling around the area. A fracture can be caused by a blow or stress to the limbs. It can also be due to medical conditions such as osteoporosis and bone cancers that increase fracture risk due to bone weakening. People susceptible to bone fracture are those who have suffered from previous falls or limb injuries, menopausal women, elderly and children.

And, what if you do fall? Well, a fall can spell havoc for your existing fractures. Plus, the tendency to fall is also increased if you have health issues such as poor vision, stroke, Parkinson’s disease, or dementia. And here’s the catch, more than half of all fall cases happens at home! Now, you wouldn’t want that, would you?

Just like the saying “good practices start from home”, you should start preventing falls in your very own home. As we spend most of our times at home if not out, the risk of a fall is naturally greater there than at anywhere else. But, fret not.

There are simple adjustments you can make to ensure that your house is as fracture-proof as it can be.

Keep the floor clear.

Clean spills immediately.
Put things back where they belong whenever they are spotted lying about.
Ensure the floors are swept to remove trip hazards such as grains and small rocks.
Sharp objects such as a broken glass should be cleared away immediately.
Electrical wires and cords should be kept off the floor and be coiled where possible.

Aim for smooth surfaces.

If you are using carpets at home, make sure that they are secured smoothly to the floor.
Avoid carpet textures that can increase a fall risk.
For houses with floor tiles, use a non-skid wax when waxing.
Dry mop the floor.
The floor should be non-slippery and dry.

Make the bathrooms secure.

Install railings or grab bars near the toilet, bathtub, and shower to provide support and to allow more secure movement.
Put a bath mat in the tub or shower so that it would not be slippery.
Ensure the bathroom lights are bright enough.
Wear non-slip slippers in the bathroom if you must.

Don’t forget the stairs, rooms and other areas.

Make sure that there is enough walking space in between furniture.
Ensure stairways and hallways are brightly lit.
Switches for lamps and other appliances should be easily accessible.
Secure the stair railing.
Keep items within an arm’s reach and avoid using stools.
Where a step stool is needed, make sure it is wide and sturdy enough and that it comes with a handrail.
You may want to purchase a cordless phone to make dialling for help and receiving calls easier.

And lastly, the outdoors.

Ensure the lighting of the house exterior is functioning and sufficiently bright.
Mend or remove trip hazards such as gravels, broken tiles and other rough spots.
If there are ramps, make sure that the railings are sturdy and secured.
Wear shoes or boots with proper grip when going out.

That aside, doing exercises may also improve your balance and reduces your risk of a fall. Tai Chi, for instance, is shown to promote proper balance in the elderly.

Exercise can also strengthen your bones and coordination! But of course, exercise alone is not enough. You should also eat a diet that is calcium and vitamin D-rich such as milk, soy beans, and broccoli. Avoid smoking and consumption of alcohol as well, if possible.

So, that’s it! Simple measures for keeping safe while reducing fall risks. Do remember to consult the doctor if you would like to find out more about bone fracture risk factors or even just bone health in general. And again, don’t forget to fracture-proof your home!

References:

About Health. Available at www.about.com

Medical News Today. Available at www.medicalnewstoday.com

National Osteoporosis Foundation. Available at www.nof.org

NIH Osteoporosis and Related Bone Diseases National Resource Center. Available at www.niams.nih.gov

WebMD. Available at www.webmd.com

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Rescheduling Motherhood?

April 28, 2022 Return

Dr Eeson Sinthamoney Consultant Obstetrician, Gynaecologist and Fertility Specialist

A sad fact of life is that biology is not feminist in nature. Women may have come a long way when it comes to attaining equal rights and becoming more independent, but human biology remains primordial. A woman’s peak fertility period is still in her late teens to her twenties – a time when she may not be ready to become a mother. By the time she is 35 (ironically the age when she may be ready to settle down), a woman’s chance of conceiving per month decreases by half. By age 45, natural fertility is reduced to only one percent.

Ah, but just imagine never having to worry about ‘baby panic’ or the biological clock counting down after hitting the big three-oh: being able to focus on establishing a career, working toward financial stability or emotional readiness. What’s more, if Mr Right is taking his time to show up, it’s no big deal – a lady can wait and not have to settle for less.

If that sounds great, well, these choices are now increasingly possible, thanks to advances in a procedure called egg freezing.

A woman may still have it all

Just like its name states, the procedure involves storing extracted eggs in a very cold environment. The very low temperature keeps the eggs in suspended animation, so that when they are thawed (even years down the road), they can be used to conceive a baby.

Fertility specialist Dr Eeson Sinthamoney explains that, traditionally, egg freezing is viewed as a method to preserve the fertility of women who are about to undergo chemotherapy or other forms of treatment that would affect their ability to produce healthy eggs in the future.

This is still true today, but egg freezing has evolved to become a solution for every woman who wishes to preserve her fertility.

The evolution is made possible because recent improvements made to egg-freezing technology have improved its chances of success.

Dr Eeson explains that, in the past, the freezing process could cause ice crystals to form in the eggs, damaging their structure and making them unusable when thawed.

This changed when a technique called vitrification was developed recently. The technique freezes the eggs very rapidly in order to prevent ice crystal formation. “The eggs can survive better because there is less damage,” Dr Eeson says. As a result, the success rate of egg freezing has improved tremendously. Dr Eeson describes this development as a ‘game-changer’ when it comes to preserving a woman’s fertility.

There’s still a catch

Unfortunately, there’s never a foolproof solution. Dr Eeson notes that there are many other factors determining the odds of success.

For example, the eggs that were harvested may already have some abnormalities in them that prevent a successful pregnancy. “The best time for egg freezing to take place is when the woman is in her late twenties to early thirties,” Dr Eeson says. Any later and it may be harder for the fertility specialist to extract enough healthy eggs for future use. This is because a woman is born with only a fixed number of eggs, which decreases as she grows older, and the eggs may also contain more abnormalities as time goes by.

Also, some eggs may be more susceptible to damage compared to others. Fertility specialists do not have a reliable way to ensure that all harvested and frozen eggs are normal or will be able to withstand the freezing process. Hence, there is no guarantee of a healthy pregnancy.

Freezing embryos? Dr Eeson points out that a frozen embryo has a higher chance of resulting in a successful pregnancy compared to a frozen egg. However, the freezing of embryos raises a few issues. One, this may not be an option for an unmarried woman. Two, the freezing of an embryo raises ethical concerns as not all frozen embryos will eventually be used and the unused ones would have to be discarded as a result.

What is the procedure like?

The first step is always a consultation, during which the fertility specialist will review the procedure thoroughly with the client. The specialist will also discuss the risks and address any concerns the client may have.
The fertility specialist will then conduct a pre-screening test, called the ovarian reserve testing. This is a simple blood test, usually taken on day three of the menstrual cycle, in which the blood sample is used to measure the levels of anti-Müllerian hormone present. The results will give the fertility specialist a good idea of the woman’s ovarian reserve, which is the number of eggs remaining in her ovaries.
Once all is in order, the client will receive fertility injections to stimulate the production of a large number of eggs.
When the time is right, the fertility specialist would retrieve the eggs while the woman is under deep sedation. This is done using a needle under the guidance of an ultrasound.
The eggs will then be frozen. Special chemicals called cryoprotectants may be used to prevent ice crystal formation.

The entire procedure would take about 10 to 14 days, and would not disrupt the woman’s normal routine much, says Dr Eeson.

For a reasonable annual fee, the fertility centre will store the eggs until they are needed.

Frequently asked questions

How long can the eggs keep?
They can keep for a long time, Dr Eeson says. In fact, the actual limiting issue is the age of the woman when she wants to be a mother. Most fertility specialists would prefer that the woman uses her frozen eggs before she turns 50, as pregnancy at age 50 and above has its share of potential complications.
What happens if the frozen specimens end up missing or damaged?
Consent forms will have to be signed before any procedure takes place to define what the fertility centre will and will not be held accountable for. Generally, the fertility centre will not be held accountable for any damages that are caused by what’s known as ‘acts of God’: natural disasters and other events that cannot be avoided by any amount of foresight or precautionary measures. If you suspect that the fertility centre has been negligent, you should consult a lawyer for further action.

What happens if the fertility centre goes out of business? What will happen to the frozen eggs?
To the best of Dr Eeson’s knowledge, there are currently no laws or regulations in Malaysia that set out the course of action required when a fertility centre closes shop. To date, no one in Malaysia has had to face such a situation.

Normally, an ethical fertility centre will make arrangements for another fertility centre to take custody of its frozen specimens. Perhaps the best course of action is to ask the fertility centre about this beforehand, as each centre may have its own contingency plan for such a situation.

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